What

U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
National Cancer Institute
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This booklet is about multiple
myeloma. The Cancer Information
Service can help you learn more about
this disease. The staff can talk with you
in English or Spanish.
The number is 1–800–4–CANCER
(1–800–422–6237). The number for
callers with TTY equipment is
1–800–332–8615. Your call is free.

U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
National Cancer Institute
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What You Need To Know About™ Multiple
Myeloma

his National Cancer Institute (NCI) booklet has
T important information about multiple myeloma,*
cancer that starts in certain white blood cells (plasma
cells). You will read about possible causes, symptoms,
diagnosis, treatment, and supportive care. You also will
find ideas about how to cope with the disease.
Each year, about 15,000 Americans learn they have
multiple myeloma. Scientists are studying this disease
to find out more about how it develops. And they are
looking at better ways to treat it.
The NCI provides information about cancer,
including the publications mentioned in this booklet.
You can order these materials by telephone or on the
Internet. You can also read them on the Internet and
print your own copy.
• Telephone (1–800–4–CANCER): Information
Specialists at NCI’s Cancer Information Service can
answer your questions about cancer. They also can
send NCI booklets, fact sheets, and other materials.
• Internet (http://www.cancer.gov): You can
use NCI’s Web site to find a wide range of
up-to-date information. For example, you can
find many NCI booklets and fact sheets at
http://www.cancer.gov/publications. People in the
United States and its territories may use this Web
site to order printed copies. This Web site also
explains how people outside the United States can
mail or fax their requests for NCI booklets.

*Words that may be new to readers appear in italics. The
“Dictionary” section explains these terms. Some words in the
“Dictionary” have a “sounds-like” spelling to show how to pronounce
them.

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You can ask questions online and get help right
away from Information Specialists through
LiveHelp. (Click on the “Need Help?” at
http://www.cancer.gov. Then click on “Connect
to LiveHelp.”)

What Is Multiple Myeloma?

ultiple myeloma is cancer that begins in plasma
M cells, a type of white blood cell. To understand
multiple myeloma, it is helpful to know about normal
blood cells.

Normal Blood Cells
Most blood cells develop from cells in the bone
marrow called stem cells. Bone marrow is the soft
material in the center of most bones.
Stem cells mature into different types of blood cells.
Each type has a special function:
• White blood cells help fight infection. There are
several types of white blood cells.
• Red blood cells carry oxygen to tissues throughout
the body.
• Platelets help form blood clots that control bleeding.
Plasma cells are white blood cells that make
antibodies. Antibodies are part of the immune system.
They work with other parts of the immune system to
help protect the body from germs and other harmful
substances. Each type of plasma cell makes a different
antibody.

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Plasma cell makes antibodies

Antibodies
bind to germ

Antibodies work with other parts of the
immune system to destroy the germ
Normal plasma cells help protect the body from
germs and other harmful substances.

Myeloma Cells
Myeloma, like other cancers, begins in cells.
Normally, cells grow and divide to form new cells as
the body needs them. When cells grow old, they die,
and new cells take their place. In cancer, this orderly
process goes wrong. New cells form when the body
does not need them, and old cells do not die when they
should. These extra cells can form a mass of tissue
called a growth or tumor.

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Myeloma begins when a plasma cell becomes
abnormal. The abnormal cell divides to make copies of
itself. The new cells divide again and again, making
more and more abnormal cells. The abnormal plasma
cells are myeloma cells. Myeloma cells make
antibodies called M proteins.
In time, myeloma cells collect in the bone marrow.
They may crowd out normal blood cells. Myeloma
cells also collect in the solid part of the bone. The
disease is called “multiple myeloma” because it affects
many bones. (If myeloma cells collect in only one
bone, the single mass is called a plasmacytoma.)
Multiple myeloma is the most common type of
plasma cell tumor. This booklet does not deal with
other kinds of plasma cell tumors. The Cancer

Myeloma cells

M proteins

Myeloma cells (abnormal plasma cells) making
M proteins.

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Information Service (1–800–4–CANCER) can send
information about those diseases.

Multiple myeloma is not bone cancer.
Although multiple myeloma affects the bones, it
begins in blood cells, not bone cells.
Bone cancer is a different disease. It begins in
bone cells, not blood cells. Bone cancer is
diagnosed and treated differently from multiple
myeloma.
The NCI’s fact sheet “Bone Cancer: Questions
and Answers” provides information about bone
cancer. This fact sheet and other materials are
available from the Cancer Information Service
(1–800–4–CANCER) and on NCI’s Web site
(http://www.cancer.gov).

Risk Factors

N omyeloma.
one knows the exact causes of multiple
Doctors can seldom explain why one
person develops this disease and another does not.
However, we do know that multiple myeloma is not
contagious. You cannot “catch” it from another person.
Research has shown that people with certain risk
factors are more likely than others to develop multiple
myeloma. A risk factor is something that may increase
the chance of developing a disease.

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Studies have found the following risk factors for
multiple myeloma:
• Age: Growing older increases the chance of
developing multiple myeloma. Most people with
myeloma are diagnosed after age 65. This disease is
rare in people younger than 40.
• Race: The risk of multiple myeloma is highest
among African Americans and lowest among Asian
Americans. The reason for the difference between
racial groups is not known.
• Personal history of monoclonal gammopathy of
undetermined significance (MGUS): MGUS is a
condition in which abnormal plasma cells make a
low level of M proteins. MGUS is a benign
condition, but it increases the risk of certain cancers,
including multiple myeloma.
Scientists are studying other possible risk factors for
multiple myeloma. Radiation, pesticides, hair dye,
certain viruses, obesity, and diet are under study. But it
is not clear that these factors are involved in the
development of the disease. Researchers also are
studying families in which more than one person has
multiple myeloma. However, such families are
extremely rare.
Most people who have known risk factors (being
older, being African American, or having MGUS) do
not get multiple myeloma. On the other hand, most
people who do get the disease have no known risk
factors. If you think you may be at risk, you should
discuss this concern with your doctor.

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Symptoms

ommon symptoms of multiple myeloma
C include:
• Bone pain, usually in the back
• Broken bones, usually in the spine
• Feeling weak and very tired
• Feeling very thirsty
• Frequent infections and fevers
• Weight loss
• Nausea or constipation
• Frequent urination
Most often, these symptoms are not due to cancer.
Other health problems can cause the same symptoms.
Anyone with these symptoms should tell the doctor so
that problems can be diagnosed and treated as early as
possible.

Diagnosis

D octors sometimes find multiple myeloma after a
routine blood test. More often, doctors suspect
multiple myeloma after an x-ray for a broken bone.
Usually though, patients go to the doctor because they
are having other symptoms.
To find out whether such problems are from
multiple myeloma or some other condition, your doctor
may ask about your personal and family medical
history and do a physical exam. In addition, your

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doctor may order some of the following tests and
exams:
• Blood tests: The lab checks the level of blood cells
and other substances. Myeloma causes a high level
of plasma cells and calcium. Most people with
myeloma have anemia. Myeloma also causes high
levels of certain proteins. The lab checks for M
protein, beta-2-microglobulin, and other proteins.
• Urine tests: The lab checks for Bence Jones protein,
a type of M protein, in urine. The lab measures the
amount of Bence Jones protein in urine collected
over a 24-hour period.
If the lab finds a high level of Bence Jones protein
in your urine sample, doctors will monitor your
kidneys. Bence Jones protein can clog the kidneys
and damage them.

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• X-rays: You may have x-rays to check for broken or
thinning bones.
• Biopsy: The doctor removes tissue to look for cancer
cells. A biopsy is the only sure way to know whether
myeloma cells are in the bone marrow. The doctor
removes some bone marrow from your hipbone or
another large bone. Local anesthesia helps reduce
the discomfort. A pathologist uses a microscope to
check the tissue for cancer cells.
There are two ways the doctor can obtain bone
marrow:
—Bone marrow aspiration: The doctor uses a thin
needle to remove samples of bone marrow.
—Bone marrow biopsy: The doctor uses a thick
needle to remove a small piece of bone and bone
marrow.

You may want to ask the doctor these
questions before having a biopsy:
• How will the biopsy be done?
• Where will I have my biopsy?
• How long will it take? Will I be awake? What
will I feel? Will it hurt?
• Are there any risks? What are the chances of
infection or bleeding after the procedure?
• How long will it take me to recover?
• How soon will I know the results? Who will
explain them to me?
• If I do have cancer, who will talk to me about
the next steps? When?

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Staging

f the biopsy shows that you have multiple
I myeloma, your doctor needs to know the extent
(stage) of the disease to plan the best treatment.
Staging may involve having more tests. You may have
blood tests (including beta-2-microglobulin), CT scans,
or an MRI of your bones.
Doctors may describe the disease as Stage I, Stage
II, or Stage III. Higher numbers mean that a larger
number of myeloma cells are in the body. The stage
also takes into account whether the cancer is causing
problems with your bones or kidneys.

Treatment

M any people with multiple myeloma want to take
an active part in making decisions about their
medical care. It is natural to want to learn all you can
about your disease and your treatment choices.
However, shock and stress after the diagnosis can
make it hard to think of everything you want to ask the
doctor. It often helps to make a list of questions before
an appointment.
To help remember what the doctor says, you may
take notes or ask whether you may use a tape recorder.
You may also want to have a family member or friend
with you when you talk to the doctor—to take part in
the discussion, to take notes, or just to listen.
You do not need to ask all your questions at once.
You will have other chances to ask your doctor to
explain things that are not clear and to ask for more
information.

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Your doctor may refer you to a specialist, or you
may ask for a referral. Specialists who treat multiple
myeloma include medical oncologists, radiation
oncologists, and hematologists.

Getting a Second Opinion
Before starting treatment, you might want a second
opinion about the diagnosis and treatment plan. Many
insurance companies cover a second opinion if you or
your doctor requests it. It may take some time and
effort to gather medical records and arrange to see
another doctor. Usually it is not a problem to take
several weeks to get a second opinion. In most cases,
the delay in starting treatment will not make treatment
less effective. To make sure, you should discuss this
delay with your doctor. Some people with multiple
myeloma need treatment right away.

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There are a number of ways to find a doctor for a
second opinion:
• Your doctor may refer you to one or more
specialists. At cancer centers, several specialists
often work together as a team.
• The NCI’s Cancer Information Service, at
1–800–4–CANCER, can tell you about nearby
treatment centers. Information Specialists also can
provide online assistance through LiveHelp at
http://www.cancer.gov.
• A local or state medical society, a nearby hospital, or
a medical school can usually provide the names of
specialists in your area.
• The American Board of Medical Specialties
(ABMS) has a list of doctors who have had training
and passed exams in their specialty. You can find
this list in the Official ABMS Directory of Board
Certified Medical Specialists. This Directory is in
most public libraries. Or you can look up doctors
at http://www.abms.org. (Click on “Who’s
Certified.”)
• The NCI provides a helpful fact sheet called “How
To Find a Doctor or Treatment Facility If You Have
Cancer.”
• Nonprofit organizations with an interest in multiple
myeloma may be of help. See the NCI fact sheet
“National Organizations That Offer Services to
People With Cancer and Their Families.”

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Methods of Treatment
The choice of treatment depends mainly on the stage
and symptoms of your disease. If you have multiple
myeloma without symptoms, you may not need
treatment for the cancer. The doctor monitors your
health closely so that treatment can start when you
begin to have symptoms.
If you have symptoms, your treatment will probably
involve anticancer drugs (including steroids).
Sometimes stem cell transplantation or radiation
therapy is part of the treatment plan. Your doctor can
describe your treatment choices and the expected
results of each. You and your doctor can work together
to develop a treatment plan that meets your needs.
Because standard treatment may not control
myeloma, you may want to talk to your doctor about
taking part in a clinical trial. Clinical trials are research
studies of new treatment methods. The section on “The
Promise of Cancer Research” on page 26 has more
information about clinical trials.
At any stage of disease, you may receive supportive
care to control health problems (such as infections)
caused by multiple myeloma. (See the “Supportive
Care” section on page 20.)

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You may want to ask the doctor these
questions before treatment begins:
• What is the stage of my disease?
• Is the disease affecting my kidneys?
• What are my treatment choices? Which do
you recommend for me? Will I have more
than one kind of treatment? How will my
treatment change over time?
• What are the expected benefits of each kind of
treatment?
• What are the risks and possible side effects of
each treatment? What can we do to control my
side effects?
• How will treatment affect my normal
activities?
• What can I do to take care of myself during
treatment?
• What is the treatment likely to cost? Does my
insurance cover this treatment?
• How often will I need to have checkups?
• Would a clinical trial (research study) be
appropriate for me?

Anticancer Drug Therapy
Treatment of myeloma usually involves anticancer
drugs. This treatment is called systemic therapy because
the drugs enter the bloodstream and can affect myeloma
cells all over the body.

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Many different types of drugs are used to treat
myeloma. Each type kills cancer cells in a different
way.
Types of chemotherapy in common use include
melphalan, cyclophosphamide, vincristine, and
doxorubicin. Prednisone is a steroid that is often used.
In some cases, the doctor may suggest new options,
such as thalidomide and bortezomib. People often
receive a combination of drugs.
You may receive the drugs by mouth or through a
vein. The treatment usually takes place in an outpatient
part of the hospital, at your doctor’s office, or at home.
Patients rarely need to stay in the hospital during
treatment.

You may want to ask the doctor these
questions before having anticancer drug therapy:
• Which drug or drugs will I have?
• What are the expected benefits of the
treatment?
• What are the risks and possible side effects of
treatment? What can we do about them?
• Are there any long-term effects?
• When will treatment start? When will it end?
• How will treatment affect my normal
activities?

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Stem Cell Transplantation
Some people with multiple myeloma have stem cell
transplantation. A stem cell transplant allows a person
to receive high doses of chemotherapy, radiation
therapy, or both. The high doses destroy both myeloma
cells and normal blood cells in the bone marrow. Later,
the patient receives healthy stem cells through a
flexible tube placed in a large vein in the neck or chest
area. New blood cells develop from the transplanted
stem cells.
Stem cell transplants take place in the hospital.
Some patients have two or more transplants.
Stem cells may come from the patient or from a
donor:
• Autologous stem cell transplantation: This type of
transplant uses the patient’s own stem cells. The
stem cells are removed from the patient. They may
be treated to kill myeloma cells that may be present.
The stem cells are frozen and stored. After the
patient has high-dose treatment, the stored stem cells
are thawed and returned to the patient.
• Allogeneic stem cell transplantation: Sometimes
healthy stem cells from a donor are available. The
patient’s brother, sister, or parent may be the donor.
Or the stem cells may come from an unrelated
donor. Doctors use blood tests to be sure the donor’s
cells match the patient’s cells.
• Syngeneic stem cell transplantation: This type of
transplant uses stem cells from the patient’s healthy
identical twin.

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You may want to ask the doctor these
questions before having a stem cell transplant:
• What are the possible benefits and risks of
different types of transplants?
• What kind of stem cell transplant will I have?
If I need a donor, how will we find one?
• How long will I need to be in the hospital?
Will I need special care?
• How will we know if the treatment is working?
• What can we do about side effects?
• How will treatment affect my normal
activities?
• What is my chance of a full recovery?

Radiation Therapy
Radiation therapy (also called radiotherapy) uses
high-energy rays to kill myeloma cells and to help
control pain. People receive radiation therapy at a
hospital or clinic.
Radiation therapy is given two ways for people with
myeloma:
• Local radiation: A large machine aims radiation at
the bone or the part of the body where myeloma
cells have collected. It is local therapy because it
affects cells only in the treated area. This is the main
treatment for people with a single plasmacytoma.
People receive radiation for 4 to 5 weeks. A shorter
course of radiation therapy can be used to control
the growth of tumors in bones and help relieve pain.

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• Total-body irradiation: Some patients receive
radiation to their whole body before having stem
cell transplantation. The radiation treatments may be
given 2 to 3 times a day for several days.

You may want to ask the doctor these
questions before having radiation therapy:
• Why do I need this treatment?
• What are the risks and side effects of this
treatment? What can we do about them?
• Are there any long-term effects?
• When will the treatments begin? When will
they end?
• How will I feel during therapy?
• How will treatment affect my normal
activities?

Side Effects of Treatment

B ecause cancer treatment often damages healthy
cells and tissues, unwanted side effects are
common. Side effects depend mainly on the type and
extent of the treatment. Side effects may not be the
same for each person, and they may change from one
treatment session to the next. Before treatment starts,
your health care team will explain possible side effects
and suggest ways to help you manage them.
The NCI provides helpful booklets about cancer
treatments and coping with side effects, such as
Chemotherapy and You, Radiation Therapy and You,
and Eating Hints for Cancer Patients.

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Anticancer Drug Therapy
The side effects of anticancer drugs depend mainly
on the specific drugs and the dose. The drugs affect
cancer cells and other cells that divide rapidly:
• Blood cells: When drugs affect your healthy blood
cells, you are more likely to get infections, bruise or
bleed easily, and feel very weak and tired.
• Cells in hair roots: Anticancer drugs can cause you
to lose your hair. The hair will grow back, but it
may be somewhat different in color and texture.
• Cells that line the digestive tract: Anticancer drugs
can cause poor appetite, nausea and vomiting,
diarrhea, or mouth and lip sores.
The drugs used for myeloma also may cause skin
rash, blisters, cramps, blurred vision, lung problems,
headache, dizziness, drowsiness, numbness or tingling
in hands or feet, and blood clots.
Your doctor can suggest ways to control many of
these side effects.

Stem Cell Transplantation
People who have stem cell transplantation face an
increased risk of infection, bleeding, and other side
effects because of the large doses of chemotherapy or
radiation they receive. In addition, graft-versus-host
disease (GVHD) may occur in people who receive
stem cells from a donor. In GVHD, the donated stem
cells react against the patient’s tissues. Most often,
GVHD affects the liver, skin, or digestive tract. GVHD
can be severe or even fatal. It can occur any time after
the transplant, even years later. Steroids or other drugs
may help treat or control GVHD.

Radiation Therapy
The side effects of radiation therapy depend mainly
on the dose of radiation and the part of the body that is
treated. For example, your skin in the treated area may
become red, dry, and tender. You also may lose your
hair in the treated area.
You are likely to become very tired during radiation
therapy, especially in the later weeks of treatment.
Resting is important, but doctors usually advise
patients to try to stay as active as they can.
Although the side effects of radiation therapy can be
distressing, your doctor can usually relieve them.

Supportive Care

M ultiple myeloma and its treatment can lead to
other health problems. You probably will receive
supportive care to prevent or control these problems
and to improve your comfort and quality of life.
This section tells about health problems that
myeloma may cause and describes the supportive care
people may need. Detailed information about
supportive care is available on NCI’s Web site at
http://www.cancer.gov/cancerinfo/coping and from
NCI’s Cancer Information Service at
1–800–4–CANCER.

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Infection
People with multiple myeloma get infections very
easily. You may receive antibiotics and other drugs to
help protect you. Your health care team may advise you
to stay away from crowds and from people with colds
or other contagious diseases. If an infection develops, it
can be serious and should be treated promptly. Some
people need to stay in the hospital for treatment.

Anemia
Myeloma and its treatment can lead to anemia,
which may make you feel very tired. Drugs or blood
transfusions can help with this problem.

Pain
Multiple myeloma often causes bone pain. Your
health care provider can suggest ways to relieve or
reduce pain. For example, drugs and local radiation
therapy can help control bone pain. A brace may relieve
pain in the neck or back. Some people get pain relief
from massage or acupuncture when used along with
other approaches. Also, the patient may learn relaxation
techniques such as listening to slow music or breathing
slowly and comfortably. Sometimes surgery is needed
if the spinal cord is compressed (squeezed).
The NCI offers booklets called Pain Control: A
Guide for People with Cancer and Their Families, Get
Relief from Cancer Pain, and Understanding Cancer
Pain.

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Thinning Bones
Myeloma cells keep new bone cells from forming,
and bones become thin wherever there are myeloma
cells. Your doctor may give you drugs to prevent bone
thinning and help reduce the risk of fractures. Physical
activity, such as walking, also helps keep bones strong.

Too Much Calcium in the Blood
Multiple myeloma may cause calcium to leave the
bones and enter the bloodstream. If you have a very
high level of calcium in your blood, you may lose your
appetite. You also may feel nauseated, restless, or
confused. A high calcium level can also make you very
tired, weak, dehydrated, and thirsty. Drinking a lot of
fluids and taking drugs that lower the calcium in the
blood can be helpful.

Kidney Problems
Some patients with multiple myeloma have kidney
problems. If the problems are severe, they may need
dialysis. Dialysis removes wastes from the blood. In
some cases, people with serious kidney problems may
need a kidney transplant.

Amyloidosis
Some people with myeloma develop amyloidosis.
Abnormal protein collects in tissues of the body. The
build-up of protein can cause many problems, some of
them severe. For example, protein can build up in the
heart, causing chest pain and swollen feet. Drugs are
used to treat amyloidosis.

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Complementary and Alternative Medicine

S ome people with cancer use complementary and
alternative medicine (CAM) to ease stress or to
reduce side effects and symptoms:
• An approach is generally called complementary
medicine when it is used along with standard
treatment.
• An approach is called alternative medicine when it is
used instead of standard treatment.
Acupuncture, massage therapy, herbal products,
vitamins or special diets, visualization, meditation, and
spiritual healing are types of CAM. Many people say
that such approaches help them feel better.
However, some types of CAM may interfere with
standard treatment. Combining CAM with standard
treatment may even be harmful. Before trying any type
of CAM, you should discuss its possible benefits and
risks with your doctor.
Some types of CAM are expensive. Health insurance
may not cover the cost.
The NCI offers a fact sheet called “Complementary
and Alternative Medicine in Cancer Treatment:
Questions and Answers.”

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Nutrition

t is important for people with multiple myeloma
I to eat well and to drink plenty of fluids. Eating
well means getting enough calories to maintain a good
weight and enough protein to keep up your strength.
Good nutrition often helps people with cancer feel
better and have more energy.
But eating well can be difficult. You may not feel
like eating if you are uncomfortable or tired. Also, the
side effects of treatment (such as poor appetite, nausea,
vomiting, or mouth sores) can be a problem. Some
people find that foods do not taste as good during
cancer therapy.

The doctor, a dietitian, or another health care
provider can suggest ways to maintain a healthy diet.

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The NCI booklet Eating Hints for Cancer Patients has
many useful ideas and recipes.

Follow-up Care

ollow-up care after treatment for multiple
F myeloma is important. Your doctor will monitor
your health and check for recurrence or changes in the
cancer. Checkups help ensure that any changes in your
health are noted and treated as needed. Checkups may
include a physical exam, lab tests, bone marrow
aspiration, and x-rays. Between scheduled visits, you
should contact the doctor right away if you have any
health problems.
To help answer questions about follow-up care and
other concerns, the NCI has a booklet for people who
have completed their treatment. Facing Forward
Series: Life After Cancer Treatment provides tips for
making the best use of medical visits. It describes how
to talk with the doctor about creating a plan of action
for recovery and future health.

Sources of Support

iving with a serious disease such as multiple
L myeloma is not easy. You may worry about caring
for your family, keeping your job, or continuing daily
activities. Concerns about treatments and managing
side effects, hospital stays, and medical bills are also
common. Doctors, nurses, and other members of the
health care team can answer questions about treatment,
work, or other activities. Meeting with a social worker,
counselor, or member of the clergy can be helpful if
you want to talk about your feelings or concerns.
Often, a social worker can suggest resources for

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financial aid, transportation, home care, or emotional
support.
Support groups also can help. In these groups,
patients or their family members meet with other
patients or their families to share what they have
learned about coping with the disease and the effects of
treatment. Groups may offer support in person, over
the telephone, or on the Internet. You may want to talk
with a member of your health care team about finding
a support group.
Cancer Information Specialists at 1–800–4–CANCER
and at LiveHelp (http://www.cancer.gov) can help you
locate programs, services, and publications. Also, you
may want to see the NCI fact sheets called “Cancer
Support Groups: Questions and Answers” and
“National Organizations That Offer Services to People
With Cancer and Their Families.”

The Promise of Cancer Research

D octors all over the country are conducting clinical
trials (research studies in which people volunteer
to take part). Many are studying new ways to treat
multiple myeloma.
Clinical trials are designed to answer important
questions and to find out whether the new treatments
are safe and effective. Research already has led to
advances, such as stem cell transplantation, and
researchers continue to look for better ways to treat
multiple myeloma.
Researchers are testing anticancer drugs (such as
thalidomide and bortezomib) and drug combinations.
They are also testing ways to improve stem cell
transplantation for people with multiple myeloma.

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People who join clinical trials may be among the
first to benefit if a new approach is effective. And even
if participants do not benefit directly, they still make an
important contribution to medicine by helping doctors
learn more about the disease and how to control it.
Although clinical trials may pose some risks,
researchers do all they can to protect their patients.
If you are interested in being part of a clinical trial,
you should talk with your doctor. You may want to read
the NCI booklet Taking Part in Clinical Trials: What
Cancer Patients Need To Know. The NCI also offers an
easy-to-read brochure called If You Have Cancer…
What You Should Know About Clinical Trials. These
NCI publications describe how clinical trials are carried
out and explain their possible benefits and risks.
NCI’s Web site includes a section on clinical trials
at http://www.cancer.gov/clinical_trials. It has general
information about clinical trials as well
as detailed information about specific ongoing
studies of multiple myeloma. Information Specialists
at 1–800–4–CANCER or at LiveHelp at
http://www.cancer.gov can answer questions and
provide information about clinical trials.

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Dictionary

Abnormal: Not normal. An abnormal lesion or growth
may be cancerous, premalignant (likely to become
cancer), or benign.
Acupuncture (AK-yoo-PUNK-chur): The technique of
inserting thin needles through the skin at specific
points on the body to control pain and other symptoms.
It is a type of complementary and alternative medicine.
Allogeneic stem cell transplantation (AL-o-jen-AY-
ik): A procedure in which a person receives stem cells
(cells from which all blood cells develop) from
someone else, a genetically similar, but not identical,
donor. This is often a sister or brother, but could be
someone the person does not know (an unrelated
donor).
Alternative medicine: Practices used instead of
standard treatments. They generally are not recognized
by the medical community as standard or conventional
medical approaches. Alternative medicine includes
dietary supplements, megadose vitamins, herbal
preparations, special teas, acupuncture, massage
therapy, magnet therapy, spiritual healing, and
meditation.
Amyloidosis (am-uh-loy-DOE-sis): A group of diseases
in which protein is deposited in specific organs
(localized amyloidosis) or throughout the body
(systemic amyloidosis). Amyloidosis may be either
primary (with no known cause) or secondary (caused
by another disease, including some types of cancer).
Generally, primary amyloidosis affects the nerves, skin,
tongue, joints, heart, and liver; secondary amyloidosis
often affects the spleen, kidneys, liver, and adrenal
glands.

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Anemia (a-NEE-mee-a): A condition in which the
number of red blood cells is below normal.
Antibody (AN-tih-BOD-ee): A type of protein made by
certain white blood cells (plasma cells) in response to a
foreign substance (antigen). Each antibody can bind to
only one specific antigen. The purpose of this binding
is to help destroy the antigen. Antibodies can work in
several ways, depending on the nature of the antigen.
Some antibodies destroy antigens directly. Others make
it easier for white blood cells to destroy the antigen.
Autologous stem cell transplantation (aw-TAHL-o-
gus): A procedure in which blood-forming stem cells
(cells from which all blood cells develop) are removed,
stored, and later given back to the same person.
Bence Jones protein: A small protein made by plasma
cells, a type of white blood cell. It is found in the urine
of most people with multiple myeloma (cancer that
arises in plasma cells).
Benign (beh-NINE): Not cancerous. Benign tumors do
not spread to tissues around them or to other parts of
the body.
Beta-2-microglobulin (MY-kroh-GLOB-yoo-lin): A
protein sometimes found in an increased amount in the
blood that may suggest the presence of some types of
cancer, such as myeloma or lymphoma.
Biopsy (BY-op-see): The removal of cells or tissues for
examination by a pathologist. The pathologist may
study the tissue under a microscope or perform other
tests. When only a sample of tissue is removed, the
procedure is called an incisional biopsy. When an
entire lump or suspicious area is removed, the
procedure is called an excisional biopsy. When a
sample of tissue or fluid is removed with a needle, the
procedure is called a needle biopsy, core biopsy, or
fine-needle aspiration.

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Blood transfusion: The administration of blood or
blood products into a blood vessel.
Bone marrow: The soft, sponge-like tissue in the center
of most bones. It produces white blood cells, red blood
cells, and platelets.
Bone marrow aspiration (as-per-AY-shun): The
removal by suction of a small sample of bone marrow
(usually from the hip) through a needle for examination
under a microscope.
Bone marrow biopsy (BY-op-see): The removal of a
sample of tissue from the bone marrow with a needle
for examination under a microscope.
Bortezomib (bore-TEZ-oe-mib): A drug that is being
studied in the treatment of cancer. It belongs to the
family of drugs called dipeptidyl boronic acids. Also
called PS-341.
Calcium (KAL-see-um): A mineral found in teeth,
bones, and other body tissues.
Cancer: A term for diseases in which abnormal cells
divide without control. Cancer cells can invade nearby
tissues and can spread through the bloodstream and
lymphatic system to other parts of the body. There are
several main types of cancer. Carcinoma is cancer that
begins in the skin or in tissues that line or cover
internal organs. Sarcoma is cancer that begins in bone,
cartilage, fat, muscle, blood vessels, or other connective
or supportive tissue. Leukemia is cancer that starts in
blood-forming tissue such as the bone marrow, and
causes large numbers of abnormal blood cells to be
produced and enter the bloodstream. Lymphoma and
multiple myeloma are cancers that begin in the cells of
the immune system.
Chemotherapy (kee-mo-THER-a-pee): Treatment with
anticancer drugs.

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Clinical trial: A type of research study that tests how
well new medical interventions work in people. Such
studies test new methods of screening, prevention,
diagnosis, or treatment of a disease. Studies may be
carried out in a clinic or other medical facility. Also
called a clinical study.
Complementary and alternative medicine: CAM.
Forms of treatment that are used in addition to
(complementary) or instead of (alternative) standard
treatments. These practices generally are not considered
standard medical approaches. CAM may include
dietary supplements, megadose vitamins, herbal
preparations, special teas, acupuncture, massage
therapy, magnet therapy, spiritual healing, and
meditation.
Complementary medicine: Practices often used to
enhance or complement standard treatments. They
generally are not recognized by the medical community
as standard or conventional medical approaches.
Complementary medicine may include dietary
supplements, megadose vitamins, herbal preparations,
special teas, acupuncture, massage therapy, magnet
therapy, spiritual healing, and meditation.
Core biopsy: The removal of a tissue sample with a
needle for examination under a microscope.
CT scan: Computed tomography scan. A series of
detailed pictures of areas inside the body taken from
different angles; the pictures are created by a computer
linked to an x-ray machine. Also called computerized
tomography and computerized axial tomography (CAT)
scan.
Cyclophosphamide: An anticancer drug that belongs to
the family of drugs called alkylating agents.
Dehydration: A condition caused by the loss of too
much water from the body. Severe diarrhea or vomiting
can cause dehydration.

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Dialysis (dye-AL-ih-sis): The process of filtering the
blood when the kidneys are not able to cleanse it.
Dietitian: A health professional with special training in
nutrition who can help with dietary choices. Also
called a nutritionist.
Digestive tract (dye-JES-tiv): The organs through
which food and liquids pass when they are swallowed,
digested, and eliminated. These organs are the mouth,
esophagus, stomach, small and large intestines, and
rectum.
Doxorubicin (DAK-suh-ROO-buh-sun): An anticancer
drug that belongs to the family of drugs called
antitumor antibiotics. It is an anthracycline. Also called
Adriamycin.
Graft-versus-host disease: GVHD. A reaction of
donated stem cells against the patient’s tissue.
Hematologist (hee-ma-TOL-o-jist): A doctor who
specializes in treating blood disorders.
Immune system (im-YOON): The complex group of
organs and cells that defends the body against
infections and other diseases.
Infection: Invasion and multiplication of germs in the
body. Infections can occur in any part of the body, and
can spread throughout the body. The germs may be
bacteria, viruses, yeast, or fungi. They can cause a
fever and other problems, depending on where the
infection occurs. When the body’s natural defense
system is strong, it can often fight the germs and
prevent infection. Cancer treatment can weaken the
natural defense system.
Local anesthesia (an-es-THEE-zha): Drugs that cause
a temporary loss of feeling in one part of the body. The
patient remains awake but has no feeling in the part of
the body treated with the anesthetic.

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Local therapy: Treatment that affects cells in the tumor
and the area close to it.
M protein: An antibody or part of an antibody found in
unusually large amounts in the blood or urine of people
with multiple myeloma. Also called monoclonal
protein.
Medical oncologist (MED-i-kul on-KOL-o-jist): A
doctor who specializes in diagnosing and treating
cancer using chemotherapy, hormonal therapy, and
biological therapy. A medical oncologist often is the
main health care provider for someone who has cancer.
A medical oncologist also provides supportive care and
may coordinate treatment provided by other specialists.
Melphalan: An anticancer drug that belongs to the
family of drugs called alkylating agents.
Monoclonal gammopathy of undetermined
significance (MAH-no-KLO-nul gam-OP-uh-the):
MGUS. A benign condition that affects plasma cells, a
type of white blood cell. These abnormal plasma cells
make proteins that often show up in blood or urine
tests. MGUS sometimes leads to cancer.
MRI: Magnetic resonance imaging (mag-NET-ik REZ-
o-nans IM-a-jing). A procedure in which radio waves
and a powerful magnet linked to a computer are used to
create detailed pictures of areas inside the body. These
pictures can show the difference between normal and
diseased tissue. MRI makes better images of organs and
soft tissue than other scanning techniques, such as CT
or x-ray. MRI is especially useful for imaging the brain,
spine, the soft tissue of joints, and the inside of bones.
Also called nuclear magnetic resonance imaging.
Multiple myeloma (my-eh-LOW-ma): Cancer that
arises in plasma cells (white blood cells that produce
antibodies). Also called Kahler’s disease,
myelomatosis, or plasma cell myeloma.

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Obesity: Having an abnormally high, unhealthy amount
of body fat.
Pathologist (pa-THOL-o-jist): A doctor who identifies
diseases by studying cells and tissues under a
microscope.
Pesticide (PES-tuh-side): A chemical that kills insects
and other pests.
Plasma cell: A type of white blood cell that produces
antibodies.
Plasma cell tumor: Cancer of the plasma cells (white
blood cells that produce antibodies). Multiple myeloma
is the most common type.
Plasmacytoma (PLAZ-ma-sye-TOE-ma): Tumor made
up of cancerous plasma cells (white blood cells that
produce antibodies). It sometimes turns into multiple
myeloma.
Platelet (PLATE-let): A type of blood cell that helps
prevent bleeding by causing blood clots to form. Also
called a thrombocyte.
Prednisone: Belongs to the family of drugs called
steroids and is used to treat several types of cancer and
other disorders. Prednisone also inhibits the body’s
immune response.
Quality of life: The overall enjoyment of life. Many
clinical trials assess the effects of cancer and its
treatment on the quality of life. These studies measure
aspects of an individual’s sense of well-being and
ability to carry out various activities.
Radiation (ray-dee-AY-shun): Energy released in the
form of particles or electromagnetic waves. Common
sources of radiation include radon gas, cosmic rays
from outer space, and medical x-rays.
Radiation oncologist (ray-dee-AY-shun on-KOL-o-
jist): A doctor who specializes in using radiation to
treat cancer.

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Radiation therapy (ray-dee-AY-shun THER-ah-pee):
The use of high-energy radiation from x-rays, gamma
rays, neutrons, and other sources to kill cancer cells
and shrink tumors. Radiation may come from a
machine outside the body (external-beam radiation
therapy), or it may come from radioactive material
placed in the body near cancer cells (internal radiation
therapy, implant radiation, or brachytherapy). Systemic
radiation therapy uses a radioactive substance, such as
a radiolabeled monoclonal antibody, that circulates
throughout the body. Also called radiotherapy.
Recurrence: The return of cancer, at the same place as
the original (primary) tumor or in another location,
after the tumor had disappeared.
Red blood cell: RBC. A cell that carries oxygen to all
parts of the body. Also called an erythrocyte.
Risk factor: Something that may increase the chance
of developing a disease. Some examples of risk factors
for cancer include age, a family history of certain
cancers, use of tobacco products, certain eating habits,
obesity, exposure to radiation or other cancer-causing
agents, and certain genetic changes.
Side effect: A problem that occurs when treatment
affects healthy tissues or organs. Some common side
effects of cancer treatment are fatigue, pain, nausea,
vomiting, decreased blood cell counts, hair loss, and
mouth sores.
Stage: The extent of a cancer within the body. If the
cancer has spread, the stage describes how far it has
spread from the original site to other parts of the body.
Staging (STAY-jing): Performing exams and tests to
learn the extent of the cancer within the body,
especially whether the disease has spread from the
original site to other parts of the body. It is important
to know the stage of the disease in order to plan the
best treatment.

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Stem cell: A cell from which other types of cells
develop.
Stem cell transplantation: A method of replacing
immature blood-forming cells that were destroyed by
cancer treatment. The stem cells are given to the person
after treatment to help the bone marrow recover and
continue producing healthy blood cells.
Steroid (STAIR-oyd): A type of drug used to relieve
swelling and inflammation. Some steroids also have
antitumor effects.
Supportive care: Care given to improve the quality of
life of patients who have a serious or life-threatening
disease. The goal of supportive care is to prevent or
treat as early as possible the symptoms of the disease,
side effects caused by treatment of the disease, and
psychological, social, and spiritual problems related to
the disease or its treatment. Also called palliative care,
comfort care, and symptom management.
Symptom: An indication that a person has a condition
or disease. Some examples of symptoms are headache,
fever, fatigue, nausea, vomiting, and pain.
Syngeneic stem cell transplantation (SIN-juh-NAY-ik):
A procedure in which a patient receives stem cells
donated by his or her healthy identical twin.
Systemic therapy (sis-TEM-ik THER-a-pee): Treatment
using substances that travel through the bloodstream,
reaching and affecting cells all over the body.
Thalidomide: A drug that belongs to the family of
drugs called angiogenesis inhibitors. It prevents the
growth of new blood vessels into a solid tumor.
Tissue (TISH-oo): A group or layer of cells that work
together to perform a specific function.
Total-body irradiation: Radiation therapy to the entire
body. It is usually followed by bone marrow or
peripheral stem cell transplantation.

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Tumor (TOO-mer): An abnormal mass of tissue that
results when cells divide excessively or do not die
when they should. Tumors may be benign (not
cancerous), or malignant (cancerous). Also called
neoplasm.
Vincristine: An anticancer drug that belongs to the
family of plant drugs called vinca alkaloids.
Virus (VYE-rus): A microorganism that can infect cells
and cause disease.
White blood cell: WBC. Refers to a blood cell that
does not contain hemoglobin. White blood cells
include lymphocytes, neutrophils, eosinophils,
macrophages, and mast cells. These cells are made by
bone marrow and help the body fight infection and
other diseases.
X-ray: A type of high-energy radiation. In low doses,
x-rays are used to diagnose diseases by making
pictures of the inside of the body. In high doses, x-rays
are used to treat cancer.

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National Cancer Institute Information
Resources

Y oufamily,
may want more information for yourself, your
and your doctor. The following National
Cancer Institute (NCI) services are available to help
you.

Telephone
The Cancer Information Service (CIS) provides
accurate, up-to-date information on cancer to patients
and their families, health professionals, and the general
public. Information Specialists translate the latest
scientific information into understandable language and
respond in English, Spanish, or on TTY equipment.
Calls to the CIS are free.
Telephone: 1–800–4–CANCER (1–800–422–6237)
TTY: 1–800–332–8615

ational Cancer Institute (NCI) publications can be
N ordered by writing to the address below:
Publications Ordering Service
National Cancer Institute
Suite 3035A
6116 Executive Boulevard, MSC 8322
Bethesda, MD 20892– 8322
Many NCI publications can be viewed, downloaded,
and ordered from http://www.cancer.gov/publications
on the Internet. In addition, people in the United States
and its territories may order these and other NCI
publications by calling the Cancer Information Service
at 1–800–4–CANCER.

Publications About Living With Cancer
• Advanced Cancer: Living Each Day
• Facing Forward Series: Life After Cancer Treatment
(also available in Spanish: Siga adelante: la vida
después del tratamiento del cáncer)

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• Facing Forward Series: Ways You Can Make a
Difference in Cancer
• Taking Time: Support for People With Cancer and
the People Who Care About Them
• When Cancer Recurs: Meeting the Challenge
• “How To Find a Doctor or Treatment Facility If You
Have Cancer” (also available in Spanish: “Cómo
encontrar a un doctor o un establecimiento de
tratamiento si usted tiene cáncer”)
• “Followup Care: Questions and Answers”
• “Understanding Prognosis and Cancer Statistics”
(also available in Spanish: “La interpretación de los
pronósticos y las estadísticas del cáncer”)
• “Cancer Support Groups: Questions and Answers”
• “National Organizations That Offer Services to
People With Cancer and Their Families” (also
available in Spanish: “Organizaciones nacionales
que brindan servicios a las personas con cáncer y
sus familias”)
• “How To Find Resources in Your Own Community
If You Have Cancer” (also available in Spanish:
“Cómo encontrar recursos en su comunidad si usted
tiene cáncer”)

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The National Cancer Institute (NCI) is part of the
National Institutes of Health. NCI conducts and
supports basic and clinical research in the search for
better ways to prevent, diagnose, and treat cancer. NCI
also supports the training of scientists and is
responsible for communicating its research findings to
the medical community and the public.
The written text of NCI material is in the public
domain. It is not subject to copyright restrictions. You
do not need our permission to reproduce or translate
NCI written text. However, we would appreciate a
credit line and a copy of your translations.
Private sector designers, photographers, and
illustrators retain copyrights to artwork they develop
under contract to NCI. You must have permission to
use or reproduce these materials. In many cases, artists
will grant permission, but they may require a credit
line and/or usage fees. To inquire about permission to
reproduce NCI artwork, please write to: Office of
Communications, Communication Services Branch,
National Cancer Institute, 6116 Executive Boulevard,
Room 3066, MSC 8323, Rockville, MD 20892–8323.
What
You